And respiratory rate are within normal limits. Moderate scleral icterus is noted. The abdomen is soft and not distended. The liver is enlarged, nontender, and smooth with an edge palpable 5 cm below the costal margin and a span of 15 cm. The spleen is palpable. The cardiac, pulmonary, neurologic, and extremity examinations all are within normal limits. C.R.’s laboratory evaluation is significant for the following: Hct, 39% Hgb, 11 g/dL WBC count, 8.8 cells/?L Platelets, 75,000/?L PT, 15.4 seconds INR, 2.1 AST, 326 units/L ALT, 382 units/L Alkaline phosphatase, 142 units/mL Total bilirubin, 4.2 mg/dL Albumin, 2.8 g/dL Hepatitis serologic tests are positive for HBsAg, HBeAg, and anti-HBc and negative for IgM anti-HBc, IgM antiHAV, and anti-HCV. HBV DNA is reported as greater than 200 pg/mL. A liver biopsy reveals periportal inflammation as well as piecemeal and bridging necrosis. What clinical findings does C.R. have that support the diagnosis of chronic HBV infection?
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